Sequencing and Treatment Selection in Relapsed/Refractory Multiple Myeloma

In this closing segment, Dr. Peter Voorhees, Dr. Luciano Costa, and Dr. Doris Hansen discuss the limitations of available evidence for sequencing therapies in relapsed/refractory multiple myeloma. Dr. Costa notes that much of the sequencing evidence comes from heavily pretreated populations with relatively small sample sizes and potential selection bias, making the findings difficult to interpret and limiting their applicability to earlier-line disease. The panel discusses observations from later-line settings regarding treatment sequences involving CAR T-cell therapy and bispecific antibodies while emphasizing that whether these findings apply to early relapse remains uncertain. Dr. Costa also highlights that, when making second-line treatment decisions, clinicians may need to focus on the treatment options currently available rather than overemphasizing a hypothetical subsequent sequence. The panel reiterates the importance of shared decision-making and considering individual patient and disease characteristics. Dr. Voorhees closes by emphasizing the importance of discussing T-cell redirecting therapies with patients experiencing relapsed multiple myeloma and summarizes how emerging evidence is shaping treatment selection and sequencing across the disease continuum.